BREAST DENSITY NOTIFICATION LAW TAKES EFFECT MONDAY

Women who have dense tissue will get notification in mail

As of April 1, women in San Diego County and across the state will start getting a warning in the mail if their mammogram shows they have dense breast tissue.

Studies show that dense tissue can make preventive mammogram screenings less effective at detecting early-stage cancers.

Federal law already requires health providers to report the results of mammograms to women in writing, and now those letters will have to include an extra paragraph if density is an issue.

The law makes California the fifth state in the nation to require dense- tissue notifications. It comes with some concern from California doctors who say women might be scared by receiving the news in the mail. In addition, doctors note that follow-up scans with ultrasound technology are not yet standardized and most insurance plans do not cover such care.

Those concerns do not faze Nancy Cappello, founder of Are You Dense, a nonprofit organization that advocates for mandatory breast density notification laws.

Cappello helped pass the first such law in her home state of Connecticut after learning that dense tissue prevented early detection of her breast cancer.

While she acknowledged that the new California law is not perfect, Cappello said she believes women deserve to know where they stand.

“It’s really about informed consent that a woman understands the potential risks of her own situation,” she said. “We know that breast density is the strongest predictor of a mammogram’s failure to find your cancer. Women want to have this information, and we are big enough and bold enough not to panic. After all, we’re having a mammogram in the first place because, if we do have cancer, we want to find it early.”

A dense breast is one that has a greater-than-normal proportion of tissue to fat. Tissue, unlike fat, appears white on a mammogram and can mask the presence of cancer, which also shows up white.

“We’re trying to find little white things among white dense tissue, which can be difficult,” said Dr. Vivian Lim, a radiologist with Scripps Health.

Some studies indicate that about 40 percent of women have breasts that fall into the dense category, Lim said. Given that Scripps alone does about 50,000 mammograms per year in the county, a lot of women are about to learn about this condition, many for the first time.

Lim said patients who receive a density warning should talk to their doctors, who may decide to do a follow-up examination with an ultrasound.

The new law has come with some controversy, Lim said, because there is no set definition of what constitutes tissue density. It depends on the radiologist reading the mammogram.

Likewise, she said, there are no universally accepted rules for using ultrasound to screen breast tissue. In most cases, ultrasound is used to get more clarity on a condition ﻿that is already known, like the position of a fetus or the presence of gallstones, she said.

She said health systems will have to invest in additional training and perhaps new automated ultrasound machines to help women cope with the news that they have dense tissue.

“I’m for the law,” Lim said. “It’s just that I think it got passed without a lot of preplanning.”

Cappello said doctors in Connecticut have managed to increase their ultrasound skills following passage of the notification law.

She said San Diego County residents who are notified that they have dense breast tissue should be ready to ask questions.

“You want to ask your doctor, ‘Do you do screening ultrasounds, and what have you done to prepare yourself for this new law?’” she said.